Mesothelioma is treated with surgery, chemotherapy and radiation. Some patients receive experimental treatments through clinical trials. Mesothelioma patients today have a much higher chance of survival thanks to sophisticated surgical procedures and emerging therapies. There are specialized cancer centers across the country, including within the VA Healthcare System.
Mesothelioma Treatment Goals
Mesothelioma treatments accomplish different goals, depending on the particular patient’s case. Specialists tailor mesothelioma treatments according to each patient’s unique diagnosis. Customized treatments give patients the best chance of survival. Each patient has factors that doctors must consider before applying the right treatment approach.
Doctors look at the following factors to determine the best mesothelioma treatment options:
- Disease location (pleural, peritoneal or pericardial)
- Disease stage (pleural mesothelioma stages 1-4)
- Mesothelioma cell type (epithelioid, sarcomatoid or biphasic)
- Patient’s age and overall level of health
Different treatments have different goals. Doctors consider all possible outcomes, including potential risks and benefits. In general, doctors prescribe more aggressive therapies for less advanced mesothelioma cases.
Some of the possible goals with mesothelioma treatments include:
- Removing tumors and all visible signs of mesothelioma
- Killing cancer cells to prevent them from dividing
- Targeting cancer cells and destroying tumors
- Killing cancer cells circulating throughout the body
- Improving comfort levels through pain management
- Reducing symptoms such as fluid buildup in the chest and stomach
All treatments aim to extend life expectancy, improve quality of life or accomplish both.
Mesothelioma Treatment Types
Mesothelioma patients are living longer than ever thanks to tailored treatment plans. Mesothelioma specialists design unique treatment plans for each of their patients.
The primary treatment options for mesothelioma patients include:
- Curative surgeries that aim to remove as much of the tumor as possible
- Palliative surgeries that reduce painful symptoms
- Chemotherapy that kills cancer cells and prevents them from multiplying
- Radiation therapy that targets and destroys cancer cells
- Multimodal therapies that use a combination of 2 or more treatment methods
- Emerging therapies tested in clinical trials and studies
Surgery offers the best chances of long-term survival for mesothelioma patients. Early-stage patients are the best candidates for surgery, but patients in all stages of mesothelioma may be eligible. If you aren’t given surgery as an option, consider talking to another doctor. A second opinion from a mesothelioma specialist can save a life.
Doctors have developed different surgical procedures for treating each mesothelioma location.
Here are the main surgical treatments available for many mesothelioma patients:
- Extrapleural pneumonectomy (EPP) for pleural mesothelioma
- Pleurectomy with decortication (P/D) for pleural mesothelioma
- Cytoreduction with HIPEC for peritoneal mesothelioma
- Pericardiectomy for pericardial mesothelioma
- Palliative surgeries for all mesothelioma types
Extrapleural pneumonectomy (EPP) is a surgery used to treat pleural mesothelioma. During the EPP, the mesothelioma surgeon removes the diseased lung and parts of the chest lining and the heart lining (pericardium). The doctor may also remove a portion of the diaphragm and/or nearby lymph nodes. Early-stage patients (stage 1 and 2) often receive EPP because of its potential for success. But pleural mesothelioma patients in stage 3 or 4 have benefitted from this treatment too.
The EPP removes the diseased lung and parts of the chest cavity where the mesothelioma may have spread to. Removing the lung where the majority of the cells exist can improve a patient’s life expectancy.
On average, a patient can double their life expectancy from 12 to 24 months with an EPP. Some patients have gone on to live 5 or more years due to their EPP surgery.
The late Dr. David Sugarbaker was a pioneer for the EPP for pleural mesothelioma. He spent the last 30 years of his life developing this surgery so that more patients can benefit from it. Experts feel that survival rates will only continue to increase as specialists work to refine and advance the EPP technique, giving it a higher success rate.
The pleurectomy with decortication (P/D) is another type of surgery used to treat pleural mesothelioma patients. Individuals who undergo P/D keep their lung. Some consider P/D to be a better option compared to EPP because it saves the patient’s lung.
P/D involves a two-part surgery:
- The surgeon performs the “pleurectomy“—removing the diseased pleura (lung lining).
- The surgeon begins the “decortication“—removing visible tumor masses in the chest cavity.
Only candidates who are in good enough health to withstand surgery are eligible to receive a P/D. Like EPP, P/D is typically performed on early stage Pleural Mesothelioma patients. Some advanced stage patients are candidates for P/D.
Dr. Robert Cameron of UCLA Medical Center developed the P/D as an alternative to EPP. Dr. Cameron has spent more than two decades refining the procedure to ensure greater rates of success. As surgeons continue to improve P/D, they can increase survival rates and save more patient lives.
Though each surgical technique has passionate proponents on either side, EPP and P/D have both proven to improve patient life expectancy significantly. Like the EPP, P/D also doubles the average patient life expectancy.
Cytoreduction with HIPEC is the only surgical procedure for peritoneal mesothelioma. It’s a two-part surgical procedure.
- Cytoreduction: First, the surgeon uses a surgical technique called cytoreduction. The surgeon removes as much of the visible tumors as possible, as well as removing the diseased peritoneum (peritonectomy)—the lining of the abdominal cavity.
- HIPEC: The surgeon then applies hyperthermic intraoperative chemotherapy (HIPEC)— circulating heated chemotherapy drugs in the abdomen. HIPEC helps kill off any remaining mesothelioma cells in the abdomen. Dr. Paul Sugarbaker developed this operation for peritoneal mesothelioma.
Cytoreduction with HIPEC has resulted in an average life expectancy of 3 years for patients who undergo this surgery.
Pericardiectomy is used to treat pericardial mesothelioma. During a pericardiectomy, the surgeon removes part or all of the diseased pericardium, the lining of the heart.
Combining a pericardiectomy with chemotherapy has allowed some patients to live longer than three years after their diagnosis.
A pericardiectomy may be used as a curative surgery or a palliative surgery to help alleviate painful symptoms like difficulty breathing. In some cases, a pericardiectomy has extended a patient’s life expectancy significantly.
Palliative surgeries help increase comfort levels by alleviating symptoms. There are many types of palliative surgeries, depending on the mesothelioma location.
Most palliative surgeries involve removing parts of the diseased mesothelium and draining fluid buildup. Draining fluid helps patients by reducing their swelling and eliminating tightness in their chest or abdomen. This allows them to breathe comfortably.
Palliative surgeries don’t usually extend life expectancy, but they can help mesothelioma patients live without pain and discomfort.
Here are the different palliative surgical options:
- Pleurodesis: Prevents fluid buildup in the pleura
- Thoracentesis: Removes excess fluid between the lungs and the pleura
- Pericardiocentesis: Empties excess fluid in the pericardium
Mesothelioma specialists are the only ones who can adequately determine whether a patient is a good candidate for curative surgeries or palliative surgeries. Palliative surgeries are excellent options that specialists recommend for helping to improve a patient’s quality of life.
Chemotherapy is the most common form of treatment for mesothelioma. It involves regularly administering an anti-cancer drug to the patient.
Patients are given chemotherapy drugs in cycles, typically administered intravenously (needle in arm or port) in a three-hour session every three weeks. Patients usually receive 3-4 rounds of these sessions.
Chemotherapy can also be taken in pill form. There are many kinds of chemotherapy drugs, but mesothelioma patients usually take a combination of a drug called cisplatin and other chemo medications. Chemotherapy may produce side effects like hair loss and fatigue. Before starting your medication plan, discuss with your doctor the options for minimizing chemotherapy side effects.
Chemotherapy drugs work to stop cancer cells from multiplying, which helps slow the disease progression. Mesothelioma specialists often combine chemotherapy with surgical procedures. Chemotherapy drugs help kill remaining cancer cells that surgeons weren’t able to remove. Chemotherapy can be given before (neoadjuvant) or after (adjuvant) surgical procedures.
Radiotherapy uses high-energy rays aimed at mesothelioma tumors to help patients at all stages of mesothelioma. A specialized doctor called a radiologist maps out the location of malignant tumors. Once the radiologist has located these mesothelioma tumors, they will aim the radiation device at the patient and deliver the prescribed amount.
Radiation interferes with the DNA of mesothelioma cells. DNA interference prevents mesothelioma cells from receiving instructions to multiply. If mesothelioma cells stop multiplying, they cannot spread, which slows disease progression.
Radiation can be administered non-invasively (through the skin) using external beams. Radiotherapy can also be administered intraoperatively, which is when it is delivered directly to tumors during open surgery.
Radiotherapy is often used in addition to other treatments and is commonly part of a multimodal therapy.
Mesothelioma treatments require specialized knowledge. The doctor must completely understand each patient’s diagnosis and unique health situation. That’s why it’s critical to receive treatment from a mesothelioma specialist as opposed to a general oncologist.
Specialists can put together a tailored treatment plan that addresses each unique patient case. A custom treatment plan gives patients the best chance of survival.
The veteran’s VA Healthcare Network and private cancer centers across the nation are home to the world’s top mesothelioma specialists.
These specialists include:
- Dr. Robert Cameron: A Pleural Mesothelioma specialist known for developing the pleurectomy with decortication procedure. Dr. Cameron works out of the UCLA Medical Center and the Los Angeles VA.
- Dr. Paul Sugarbaker: A Peritoneal Mesothelioma specialist known for developing the cytoreduction with HIPEC technique. Dr. Paul Sugarbaker works out of the Washington Cancer Institute in Washington, DC.
- Dr. Avi Lebenthal: A mesothelioma specialist dedicated to treating veteran patients. Dr. Avi Lebenthal is the director of the mesothelioma program at the Boston VA Healthcare System.
Mesothelioma Cancer Centers
It’s vital to work with a mesothelioma specialist at a designated mesothelioma cancer center. Mesothelioma specialists and cancer centers are the best way to ensure you get the best chance of extending your life expectancy and improving your quality of life. These healthcare professionals dedicate their lives to working with military veterans.
Contact any of the following mesothelioma cancer centers today or call one of our patient advocates to set up an appointment:
- Brigham and Women’s Hospital in Boston, MA
- Mayo Clinic in Rochester, MN
- Boston VA Healthcare System in Boston, MA
- UCLA Medical Center and the Los Angeles VA in Los Angeles, CA
Finding and Affording Treatment
These world-class mesothelioma medical centers understand the financial burdens that veterans and their families undergo during a mesothelioma diagnosis. That’s why the administrators work directly with the patient’s insurance provider to ensure that they take care of all of their medical claims.
Not all patients have insurance coverage for their mesothelioma diagnosis. Thankfully, veterans with mesothelioma diagnoses have substantial financial support options that alleviate the burden of medical costs. These include government-funded VA treatment programs as well as private Asbestos Trust Funds for patients and their families.
Veterans who developed mesothelioma as a result of their military service are eligible for benefits and financial aid through several different agencies and organizations. The Department of Veterans Affairs is one of the most valuable organizations for mesothelioma veterans. The VA connects eligible veterans with mesothelioma treatments. These treatments are sometimes through government-funded clinical trials that provide promising emerging therapies.
Veterans can find financial help for treatment through:
- VA-affiliated mesothelioma specialists like Dr. Lebenthal
- Disability benefits and veterans pension
- Mesothelioma trust funds for victims of asbestos exposure
If you are a veteran with a mesothelioma diagnosis, you are not alone. There are many resources available that can support your treatment and recovery. Contact our VA claims agents today to learn more about your options.